The Best-Kept Secret

Misinformation and Moral Issues Limit Access to 'Morning After Pills'

On August 14, Planned Parenthood of New York City announced extended hours on Mondays at its Manhattan Center on Bleecker Street to increase the availability of emergency contraception (EC), commonly known as "the morning after pill."

In the same week, PPNYC's Othmer Institute, which promotes "reproductive freedom and healthy sexuality through innovative programs and ideas," ran an ad in The New York Timesasking, "Have youheard about emergency contraception?" Both efforts target women who, for reasons ranging from contraceptive failure to sexual assault to not using birth control, have had unprotected sex.

Although PPNYC's release touted EC as an effective method for preventing pregnancy after unprotected intercourse, it also noted that many women have difficulty obtaining it. According to Carla Goldstein, PPNYC's vice president for public affairs, "The biggest barrier is lack of knowledge and awareness about EC among women, health care providers, and pharmacists, despite the fact that survivors of rape have been getting EC in emergency rooms for over 25 years. We call it 'the best-kept secret.' "

However, a 1998 article published by Catholics for a Free Choice states that "the [Ethical and Religious Directives for Catholic Health Care Services] . . . restrict use of the morning-after pill for rape victims who go to Catholic hospitals or clinics."

"So if a rape victim—who has no choice about where an ambulance takes her—is sent to a Catholic hospital," says Goldstein, "she is further victimized." Telephone calls to the Archdiocese of New York for comment were not returned.

A recent PPNYC citywide survey of 100 pharmacists revealed that "compared to awareness [about EC] among other health professionals, the awareness of pharmacists . . . was substantially lower." Goldstein says that pharmacists are "a huge source of medical information, so if they don't know [about EC], that's a barrier."


In the U.S., EC methods include the use of hormonal pills and the copper-T intrauterine device (which can be inserted by a physician up to five days after unprotected sex). The pills—taken in two doses, ideally within 12 hours, but also effective between 72 hours and five days after unprotected sex—prevent pregnancy by inhibiting or delaying ovulation, preventing fertilization in the fallopian tube, or altering the lining of the uterus to prevent implantation of an egg, but will not end an existing pregnancy.

Research has shown that EC has no harmful side effects in a woman (or in a fetus if she is pregnant), though nausea and vomiting are common. Today, there are two products specifically manufactured and marketed as emergency contraception: Preven (a combination of the hormones estrogen and progestin) and Plan B (composed only of progestin). PPNYC offers Plan B, which causes less nausea and vomiting and reduces a woman's chance of getting pregnant by 86 percent (compared to 75 percent for Preven). The U.S. Food and Drug Administration has declared both combined-hormone and progestin-only EC to be safe and effective. EC pills are available only by prescription.

Since 1998, when Maryland passed the first "contraceptive equity bill," a law requiring insurance companies to pay for prescription contraceptives, 12 states have passed similar legislation. In New York State, two contraceptive equity bills, sponsored by Assemblywoman Susan John, Democrat from Rochester, were passed; Senate versions were not. Laurie Beck, a senior policy analyst at PPNYC, says that in this state "paying for prescription contraceptives is totally at the discretion of insurers." Because nine states passed legislation for contraceptive coverage in 1999, Beck hopes that "we might be seeing a trend. Hopefully, New York will follow suit."

A Voicetelephone survey of 33 of 235 hospitals, clinics, and private physicians citywide that offer EC revealed fees that can range from free to $200 (in some cases, there's an additional charge for a gynecological exam or for the visit). PPNYC's $55 fee includes a pregnancy test, EC pills, condoms, and one packet of oral contraceptives—if the patient wants it—for birth control. So it seems for uninsured women cost can also affect access to EC.

Nonetheless, PPNYC's CEO, Joan Malin, believes that EC is the best hope for eliminating the "approximately 100,000 unintended pregnancies and 50,000 abortions" that take place in New York City each year.


Readers can find additional info on emergency contraception and look up local providers at NOT-2-LATE.com, The Emergency Contraception Web site.


Research assistance: Eric Cohen and Alana Forbes

 
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